Does the adequacy parameter Kt/V(urea) reflect uremic toxin concentrations in hemodialysis patients?

Sunny Eloot, Wim Van Biesen, Griet Glorieux, Nathalie Neirynck, Annemieke Dhondt, Raymond Vanholder, Sunny Eloot, Wim Van Biesen, Griet Glorieux, Nathalie Neirynck, Annemieke Dhondt, Raymond Vanholder

Abstract

Hemodialysis aims at removing uremic toxins thus decreasing their concentrations. The present study investigated whether Kt/V(urea), used as marker of dialysis adequacy, is correlated with these concentrations. Predialysis blood samples were taken before a midweek session in 71 chronic HD patients. Samples were analyzed by colorimetry, HPLC, or ELISA for a broad range of uremic solutes. Solute concentrations were divided into four groups according to quartiles of Kt/V(urea), and also of different other parameters with potential impact, such as age, body weight (BW), Protein equivalent of Nitrogen Appearance (PNA), Residual Renal Function (RRF), and dialysis vintage. Dichotomic concentration comparisons were performed for gender and Diabetes Mellitus (DM). Analysis of Variance in quartiles of Kt/V(urea) did not show significant differences for any of the solute concentrations. For PNA, however, concentrations showed significant differences for urea (P<0.001), uric acid (UA), p-cresylsulfate (PCS), and free PCS (all P<0.01), and for creatinine (Crea) and hippuric acid (HA) (both P<0.05). For RRF, concentrations varied for β₂-microglobulin (P<0.001), HA, free HA, free indoxyl sulfate, and free indole acetic acid (all P<0.01), and for p-cresylglucuronide (PCG), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), free PCS, and free PCG (all P<0.05). Gender and body weight only showed differences for Crea and UA, while age, vintage, and diabetes mellitus only showed differences for one solute concentration (UA, UA, and free PCS, respectively). Multifactor analyses indicated a predominant association of concentration with protein intake and residual renal function. In conclusion, predialysis concentrations of uremic toxins seem to be dependent on protein equivalent of nitrogen appearance and residual renal function, and not on dialysis adequacy as assessed by Kt/V(urea). Efforts to control intestinal load of uremic toxin precursors by dietary or other interventions, and preserving RRF seem important approaches to decrease uremic solute concentration and by extension their toxicity.

Conflict of interest statement

Competing Interests: Raymond Vanholder receives unrestricted research grants from Fresenius Medical Care, Baxter Healthcare, Gambro, and Bellco. The funding that Raymond Vanholder received is not related to the submitted study. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1. Box plots of quartiles and…
Figure 1. Box plots of quartiles and correlations of different solute concentrations versus Kt/V, PNA, and RRF: urea in g/L (panels A, B, and C), β2M in µg/mL (panels D, E, and F), HA in mg/dL (panels G, H, and I), and free PCS in mg/dL (panels J, K, and L).
β2M: beta-2-microglobulin, HA: hippuric acid, PCS: p-cresylsulfate, PNA: protein equivalent of nitrogen appearance, RRF: residual renal function.

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